Common OB Medications Flashcards

1
Q

Pitocin (Oxytocin)
uses

A

induction of labor
control postpartum uterine bleeding
after Suction D&C

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2
Q

Pitocin (Oxytocin)
direct & indirect action

A

Indirect: increases intracellular Ca

direct: stimulates oxytocin receptor on the myometrium

~antidiuretic

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3
Q

Pitocin (Oxytocin)
contraind

A

fetal distress
unfavorable fetal positions
previous uterine rupture

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4
Q

Pitocin (Oxytocin) systemic
effects

A

flushing
brady/tachycardia
hyper/Hypotension

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5
Q

Pitocin (Oxytocin)
dose

A

Dose: 10-40 U in 1000cc LR

Post Csxn: keep uterus tight/small to prevent bleeding (KVO ~100ml/h)

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6
Q

Pitocin (Oxytocin)
onset & duration

A

onset: immediate
duration: within 1 hour

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7
Q

Pitocin (Oxytocin)
does not work until….

A

12-14 W gestation

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8
Q

Methergine (Methlyergonovine)
cannot be given via which route?

A

NEVER given IV

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9
Q

Methergine (Methlyergonovine)
drug class/substance type

A

Semisynthetic ergot alkaloid

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10
Q

Methergine (Methlyergonovine)
MoA

A

directly: acts on smooth muscle
-increases uterine motor activity
-increase tone, rate, and amplitude of contraction

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11
Q

Methergine (Methlyergonovine)
CV effects

A

alpha stimulation: Arterial vasoconstriction

inhibits endothelial derived relaxation factor release

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12
Q

Methergine (Methlyergonovine)
Contraindications

A

severe HTN
Preg induced HTN (PIH) (>140/90)
cardiac disease

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13
Q

Methergine (Methlyergonovine)
dose

A

0.2 mg IM every 2-4 hours (max 5 doses)

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14
Q

Methergine (Methlyergonovine)
onset and duration

A

onset: 2-5 min
duration: about 3 hours

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15
Q

Hemabate (Carboprost)
identity

A

Synthetic analogue of prostaglandin F2

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16
Q

Hemabate (Carboprost)
MoA

A

stimulates uterine contraction
increase of myometrial calcium
stimulates smooth muscle of GI tract to cause diarrhea

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17
Q

Hemabate (Carboprost)
effect on temperature

A

Increase in temperature possibly due to effect on hypothalamic thermoregulation

(can increase 2 degrees)

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18
Q

Hemabate (Carboprost)
contraindications

A

Airway constriction and wheezing
increase CO, BP and PVR (constriction of vascular smooth muscle)

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19
Q

Hemabate (Carboprost)
dose
onset
duration

A

Dose: 250 mcq IM repeated every 15-45 min (max 8 doses)

onset: immediate
duration: 2 hours

20
Q

Misoprostol (Cytotec)
identity

A

Synthetic prostaglandin E1

21
Q

Misoprostol (Cytotec)
uses

A

uterine atony
abortions
cervical ripening
peptic ulcer disease

22
Q

Misoprostol (Cytotec)
dose

A

1-2 tablets buccal (200 mcq each)

rectally and vaginally (By OB)

23
Q

Misoprostol (Cytotec)
onset & 1/2L

A

onset: rapid

half life: 20-40 min

24
Q

Magnesium Sulfate (MgSO4)
uses

A

prevent eclamptic seizures (decrease incidence of seizure by 50 %)
stop premature labor (tocolytic)

25
Magnesium Sulfate (MgSO4) MoA
-Inhibit ACh release at NMJ -Mild vasodilator: decreases uterine activity = increase uterine blood -dilates liver beds and kidneys to increase function -decreases SVR
26
Magnesium Sulfate (MgSO4) potentiates .......
nondepolarizers and depolarizers (prob dont need to change dose tho)
27
T/F Magnesium Sulfate (MgSO4) does not cross the placenta
False neonate may show signs of respiratory depression, apnea and decreased tone
28
Magnesium Sulfate (MgSO4) possible negative effects (not including toxicity)
Can cause pulmonary edema ? correlation with chorioamnionitis
29
Magnesium Sulfate (MgSO4) dose
4 grams over 20 min drip: 2-3 grams/ hour
30
Magnesium Sulfate (MgSO4) onset & duration
onset: immediate duration: 20-30 min with good renal perfusion
31
Magnesium Sulfate (MgSO4) must be assessing....
Deep Tendon Reflexes
32
Magnesium Toxicity Treatment
-Ca gluconate 1 gram over 2 min -fluids -diuresis -O2 -Monitor mag levels
32
Magnesium Sulfate (MgSO4) effect on uterus
Relaxes uterus a lot caution w/ uterine atony/bleeding
33
Mag therapeutic levels
4-8 (my Mag & Mesh (CO2) are the same)
34
Mag level when we start to see resp depression
10
35
Labetalol in OB
few neonatal complications (bradycardia) alpha & beta antagonist rapid onset
36
Hydralazine in OB MoA & side fx
decrease maternal BP & uterine vasc resistnce = increase Ut blood flow Limiting side effects: maternal tachy<3 (SNS reflex to direct vasodilation), vomiting, tremors
37
Hydralazine in OB vascular effects
potent vasodilator: decrease afterload & PVR (esp if used w/ volume repletion)
38
Nipride indication
acute hypertensive crisis applies to OB & everybody
39
Nipride vasc fx
potent arteriolar dilator rapid onset and short duration
40
Nipride in OB
concern for maternal/fetal cyanide toxicity unlikely if low doses 5-10 mcg/kg/min
41
T/F Nipride is long-acting
False rapid onset and short duration
42
Nitroglycerin (NTG) MoA may cause....
venodilator decrease cardiac filling pressures by acting on capacitance vessels may get reflex tachycardia
43
Volume Repletion (decrease ECF) in OB uses
for severe pre-eclampsia to improve low CO **R & L filling pressures normalize**: -CI improves -decrease mom's HR & SVR decrease -fetal circulation improves
44
Volume Repletion (decrease ECF) in OB how it works
severe preeclampsia = low CO must replenish intravasc. vol **R & L filling pressures normalize**: -CI improves -decrease mom's HR & SVR decrease -fetal circulation improves
45
Volume Repletion (decrease ECF) + hydralazine
decreased peripheral resistance (hydralazine = potent vasodilator, decreases afterload)
46
Ephedrine vs Neo in OB
**Neosynephrine is the pressor of choice in OB** maintains fetal pH ephedrine: wont decrease Ut bld flow but fetal tachy<3 & acidosis both can treat hypoTN d/t regionals